Nurse-led implementation of ETAT plus is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone

BACKGROUND: In the wake of the Ebola virus disease (EVD) epidemic in Sierra Leone, secondary care facilities faced an increase in admissions with few members of medical staff available to assess and treat patients. This led to long waiting times in hospital outpatient departments. The study was undertaken in the outpatient department of Ola During Children’s Hospital (the tertiary paediatric hospital for Sierra Leone) in the period immediately following the EVD epidemic of 2014–2015. AIMS: This retrospective analysis of operational programme data aimed to assess whether a quality-improvement approach and task-sharing between medical and nursing staff improved the quality of triage and the timeliness of care. METHODS: All staff working in the outpatient department were offered a 4-week training course, followed by on-the-job supervision and support for 6 months. Nurses who successfully completed the course were given responsibility for the initial assessment of sick patients and for prescribing and giving initial treatment. Data were collected at three points: before intervention and at 3 and 6 months after initiation of the intervention. All children presenting to the hospital for medical attention between 0800 and 1400 Monday to Friday were included. Triage assessment by the outpatient nurse was compared to that made by a clinically experienced observer, and the time taken for each child to be triaged, assessed and given initial treatment was recorded. RESULTS:Between months 0 and 6 of the intervention, detection of emergency signs by the triage nurse improved from 30% to 100%, and detection of priority signs improved from 34% to 100%. For children presenting with emergency signs, the median time between triage and full assessment improved from 57 minutes before intervention to 17 minutes at 3 months and 5 minutes at 6 months (p < 0.0005). For the same group, median time between triage and first antibiotic or antimalarial treatment improved from 220 minutes before intervention to 40 minutes at 3 months and 18 minutes at 6 months (p = 0.006). CONCLUSION: The results indicate that, with appropriate training and support, extending the emergency assessment and treatment of sick children to nursing staff in West African hospitals may improve the accuracy of triage and the time to assessment and treatment of children presenting with signs of serious illness

Energy Distribution of a Stringy Charged Black Hole

The energy distribution associated with a stringy charged black hole is studied using M{\o}ller's energy-momentum complex. Our result is reasonable and it differs from that known in literature using Einstein's energy-momentum complex.Comment: Latex, no figure

Detection and Identification of Helicobacter pullorum in Poultry Species in Upper Egypt

This work aimed to detect, identify and study the epidemiology of Helicobacter pullorum in avian species in Upper Egypt. A total of 1800 samples, including cloacal swabs, cecal swabs and livers were collected from chickens, turkeys and ducks in five different governorates in Upper Egypt. Using conventional phenotypic methods for isolation and identification, Helicobacter pullorum could be identified only from chickens with percentage 39.33% and no presence of the organism in turkeys and ducks. Sixteen randomly selected phenotypically identified Helicobacter pullorum isolates were confirmed using PCR assay based on 16S rRNA gene. In conclusion, conventional phenotypic methods for detection and differentiation of Helicobacter pullorum are often hampered by many limitations, while molecular methods, and PCR, in particular, have marked an important step forward in bacterial diagnostics and can provide a sensitive and rapid alternative method for detection and identification and highlights the potential of PCR technology in routine detection and identification of pathogens

Interleukin 6 (IL6) as a predictor outcome in patients with compensated cirrhosis and symptomatic gall stones after cholecystectomy

Compensated cirrhosis means that the liver is heavily scarred but can still perform many important functions; many peoples with compensated cirrhosis have gall bladder stones. The advantages of laparoscopic cholecystectomy (LC) for most patients have been extensively published. However its benefits and successful use in patients with cirrhosis are less documented. The study compromised 50 patients with symptomatic gallstone in compensated liver disease and undergone either open cholecystectomy (OC) or laparoscopic cholecystectomy. These patients were randomized into two groups: Group I included 24 patients who underwent OC, and group II included 26 patients who underwent LC. Patient&#8217;s age, sex, clinical presentation and Child-Turcotte-Pugh (CTP) class were documented. No patients in this study had CTP class c cirrhosis. IL-6 was measured by ELISA, postoperative pain (measured by Visual analog scale), hospital stay, blood loss, recovery time (return to work), and liver function tests were documented. IL-6 was significantly lowered at 6th hour and 12th hour post operative in LC group. Mean surgical time was significantly longer in OC than LC group, (mean &#177;SD, 96.6 &#177;32 vs 58.7 &#177; 23.8 min, P = 0.037). No patients in group II required any blood replacement in contrast to 9 patients (37.5%) in group I. Intraoperative bleeding remained significantly higher in group I (P = 0.043). No patients in group II had wound complications compared with 5 patients (29.14%) in group I. Group I had significantly longer hospital stay than group II, mean 9.0+ 1.3 days (median 7) vs 2.3 days + 1.9 (median 2.5); P = 0.001. Our results were demonstrated that laparoscopic cholecystectomy can be performed safely in patients with CTP class A and B cirrhosis. IL-6 was more significantly, increased post operatively in open cholecystectomy than laparoscopic one and it correlated well with intensity of operative trauma.&#160;Keywords: Interleukin 6; Liver cirrhosis; Cholecystectom

IMPROVING THE FRUIT YIELD AND QUALITY OF CUCUMBER BY GRAFTING ONTO DIFFERENT ROOTSTOCKS UNDER SALINE CONDITIONS

Two experiments were carried out under low polyethylene tunnels which furnished with drip irrigation during the two successive winter seasons of 2014-2015 and 2015-2016 at Elbrollous area which represents the circumstance and conditions of coastal zone of north Nile Delta kafr Elsheikh Governorate. The objective of the investigation was to find out the effect of grafting by different cucurbita rootstocks on cucumber hybrid "ESHRAK" (Cucumis sativus, L.) on vegetative growth, flowering, yield and fruit characteristics, beside nutrient contents of cucumber plants. Results showed that grafted cucumber plants on Super Shintoza led to significant increase in vegetative growth,i.e., stem length, number of leaves, number of branches and leaf area,fruit fresh weight (g), number of fruits, total yield were greater with grafted cucumber plants on Super Shintoza followed by grafted cucumber plants on cv. Ferro. However grafting had no significant effect on potassium % of fruit on both seasons. The highest total yield was obtained by grafting cucumber plants on Super Shintoza rootstock followed by grafting on cv. Ferro rootstock by 130 % and 73 %, respectively in the first season and 160% and 147 %, in the second season respectively as compared with ungrafted cucumber plants. Accordingly, this study ensured that the use of rootstocks were more beneficial than ungrafted cucumber in both tested seasons

Simplicity versus complexity in modelling groundwater recharge in Chalk catchments

Models of varying complexity are available to provide estimates of recharge in headwater Chalk catchments. Some measure of how estimates vary between different models can help guide the choice of model for a particular application. This paper compares recharge estimates derived from four models employing input data at varying spatial resolutions for a Chalk headwater catchment (River Pang, UK) over a four-year period (1992-1995) that includes a range of climatic conditions. One model was validated against river flow data to provide a measure of their relative performance. Each model gave similar total recharge for the crucial winter recharge period when evaporation is low. However, the simple models produced relatively lower estimates of the summer and early autumn recharge due to the way in which processes governing recharge especially evaporation and infiltration are represented. The relative uniformity of land use, soil types and rainfall across headwater, drift-free Chalk catchments suggests that complex, distributed models offer limited benefits for recharge estimates at the catchment scale compared to simple models. Nonetheless, distributed models would be justified for studies where the pattern and amount of recharge need to be known in greater detail and to provide more reliable estimates of recharge during years with low rainfall.</p> <p style='line-height: 20px;'><b>Keywords:</b> Chalk, modelling, groundwater recharge</p

Does lidocaine gel produce an effective analgesia prior to copper IUD insertion? Randomized clinical trial

Background: IUD is a small contraceptive device, often containing either copper or levonorgestrel, which is inserted into the uterus. Objective of present study was to determine if lidocaine gel prior to intrauterine device (IUD) insertion decreases pain with the insertion procedure among multiparous women choosing the copper T380A-IUD.Methods: It is a randomized double-blind controlled trial carried out at Assiut Women's Health Hospital, Assiut, Egypt. Parous women eligible for Copper IUD insertion attended the Family Planning Clinic were recruited and randomized in a 1:1 ratio to lidocaine gel or placebo. Two ml of the study medications were topically placed on the cervix 3 minutes before IUD insertion. The primary outcome was the difference in pain scores using a 10-cm Visual Analogue Scale (VAS) during IUD insertion. We considered a 1.5 cm difference in VAS scores between study groups as clinically significant.Results: One hundred women consented to participate and randomized either to group I:  lidocaine group or group II: placebo group. Both groups were homogenous in baseline socio-demographic data. There was significant difference in mean pain scores for IUD placement between women who received lidocaine gel and placebo at two steps of insertion (at vulsellum application and at uterine sounding) while the rest of steps show no statistical significant difference (p=0.000). There were no statistical significant differences between both group as regard the ease of insertion, the duration of insertion and the satisfaction score after the procedure (p>0.05).Conclusions: This study depicts that the use of lidocaine gel prior to copper IUD insertion in multiparous women could partially reduce the pain during tenaculum placement and uterine sounding

OPTIMAL REQUIREMENTS OF NITROGEN AND PHOSPHORUS FERTILIZATION RATES FOR STRAWBERRY NURSERIES

Due to the expansion of strawberry nursery cultivation, transplant production has become an important industry in Egypt. Nitrogen and phosphorus are the most important nutrients affecting the number and quality of strawberry transplants. However, no empirical research exists addressing the optimal requirements of nitrogen and phosphorus fertilization rates for strawberry nurseries in Egypt, until now. This study was conducted at a private farm in Abo Ghalib, Giza Governorate, Egypt during the two successive summer seasons of 2015 and 2016 to determine the optimal requirements of nitrogen and phosphorus fertilizations for Festival strawberry cultivar nurseries via evaluating the influence of four nitrogen rates (83, 100, 117 or 134 kg N/feddan) and five phosphorus rates (38, 62, 74, 86 or 98 kg P2O5/feddan) in a factorial experiment. Results revealed that increasing the rates of nitrogen and phosphorus fertilizations increased the number of main runners/mother plant and number of marketable transplants/m2, and enhanced all vegetative growth parameters, leaf SPAD readings, leaf relative water content, crown diameter, crown carbohydrates, and leaf mineral content in both growing seasons. On the contrary, both elements had an inverse effect on leaf total soluble phenols. Thus, the study recommends to the nurserymen of Festival straw-berry cultivar to apply 117 or 134 kg N with 98 kg P2O5 per feddan under pure sandy soil condition which gave the highest number of transplants with high quality and subsequent high quality crop in the field

The effectiveness of some pesticides in the control of thrips and red spider mites on strawberry plants

This study was carried out in a private farm in Wardan, Giza governorate in Egypt during 2019 season on strawberry plants. The first experiment aimed to evaluate the effectiveness of different commercial products in cultivated land including Solo 24% SC (Bifenazate), Arbus 12% SC (Chlorfenapyr + Emamectin benzoate) , Concor 24% SC (Spirodiclofen), Excellent 1.9% EC (Emamectin benzoate) , Top9 (Chitosan 0.1%) , Biomectin 5% EC (Abamectin) and Congest 15% CS (Abamectin + Imidacloprid) in reducing the population densities of two spotted spider mite, Tetranychus uriticae Koch. on strawberry plants. According to general mean percentage of reduction in population of T. uriticae, data showed insignificant differences among the seven tested compounds whereas the mortality percentages were 85.94 %, 82.18%, 81.4%, 79.36%, 78.14%, 77.94% and 75.9%, respectively. From these results; it’s clear that Solo compound is the most effective compound and Congest is the lowest one. The other compounds ranged between them in controlling T. uriticae under these experimental conditions. The second experiment evaluated the effectiveness of different formulations in the nursery including Radiant (Spinetoram 12% Sc), Super Rigo (Naphthyl acetic acid – Chitosan), Top9 and Berna Star (Glyceryl stearate 32%) in reducing the population densities of western flower thrips, Frankliniella occidentalis (Pergande) on strawberry plants. According to general mean percentage of reduction in population of F. occidentalis, data showed significant differences among the four compounds. These compounds could be divided into three groups. The first group contained Radiant compound showing high mortality (63.5%). The second group contained Super Rigo and Top9 compounds showing moderate effect (46.44% & 34.3%), respectively. The third group contained Berna Star compound showing least effect (28.36%). From these results; it’s clear that the chemical compound Radiant is the most effective while the natural compound Berna Star is the lowest in controlling F. occidentalis under these experimental conditions